The purpose of this blog is to gather information about how to support caregivers of children. The quality of the caregiving relationship in infants and young children, central to the healthy development of the growing child, can be enhanced by attention to the caregivers in the form of education and other support. This blog will become an archive for information on these issues.

Tag Archives: separation

Important Note: The image in this post and in all the previous ones are not images of the children discussed in the posting. They are simply children whose photos I have collected throughout my travels.

It is back to school time again. Returning to school after summer vacation is a major transition. We have talked about transitions and what a challenge they are for everybody, especially for young children and vulnerable children of any age. Here are some ideas about how to make back to school time easier for everyone.

Try to Be Calm and Relaxed

Parents’ communication of anxiety to their child plays a significant role in the anxiety experienced by the child. Evidence for this influence is presented in a recent review of 15 studies addressing the question of the extent to which fear-relevant features of parental verbal communications affected the child (Percy et al, 2016). However, scientific studies are not necessary to convince teachers of this fact. Observations in a typical classroom offer support for this important dynamic. For example, I observed a father dropping off his 4-year old daughter, giving her a hug, and asking her, “Will you be all right, now?” She said, “Yes, Daddy.” The father responded, “Are you sure?”

In fact, much of this communication occurs nonverbally in parents’ behavior – such as lingering in the classroom, returning to the child after the initial good bye to add some information or give some advice. After the child is in the hands of the teacher, it is almost never a good idea for the parent to return if the child complains or even cries.

Positive Communication

For young child, the most effective way parents can support him or her at drop off is to communicate positive feelings about the experience, to “hand off” the child to a teacher, and to leave. For example, a parent might find a teacher and in the child’s presence tell the teacher something about the ride to school or the child’s excitement about the class activity planned for the day, reassure the child about who is picking up the child and when, give the child a hug, and say good bye.

Child’s anxiety

All children have some anxiety about returning to school – usually to a new classroom, a new teacher, and new classmates. Children express their anxiety in different ways. Most young children express their anxiety verbally and by clinging to a parent. Other children express it by running from one activity to another in a dysregulated manner. And others become more constrained, holding themselves in, sitting quietly and avoiding taking risks.

Some children are particularly vulnerable to separations and transitions and need extra support. Some need to bring a comforting object from home to help with the transition (although that object must usually be put away after the class begins). A goodbye ritual is helpful to all children. The parent can help the child hang up her coat, check the schedule for the day, wash her hands, etc. In some of the classrooms of the preschool where I work there is a “goodbye window” where parents can say another goodbye after they have exited the school building.

Listening to Your Child

Communicating positive expectations to the child does not mean that the parent – or teacher – refuses to listen to the child’s concerns. No matter how unrealistic the child’s fears might be, the adult must take them seriously as fears – not as reality – and validate them. For example, the child may say, “You won’t come to pick me up!” The parent must respond with some kind of acknowledgement of the child’s fear that he will be abandoned in this scary place, while also reassuring him that his fears are unjustified. For example, she might say, “That is such a scary thought, that I wouldn’t pick you up. I know you are scared. But you know that I really will pick you up at lunchtime and that Ms. Smith (the teacher) will take good care of you until then. You are going to have a cooking activity today. You know how much you love that!”

Familiarity with the School

Familiarity with the school helps too. Most schools have visiting days, but some children need time to familiarize themselves with the school without the noise and activity of many other children and parents. Other ways to help the child feel comfortable include coming to the school when it is not in session and playing on the playground (if that is permitted) or walking around the building and pointing out where the child’s classroom is located, where the parent will bring the child and pick her up.

Get to School On Time

Getting to school on time is important for many reasons. At the beginning of the school day the teachers have more availability to greet the child and parent than when groups of children and parents descend on the classroom. The classroom is less noisy and has less physical activity – sensory challenges that are particularly hard for some children. Being rushed does not lend itself to a positive good bye. Also, teachers usually plan “free play” time at the beginning of the day, and if children come to class late, they miss that important and enjoyable time.

I have promised to discuss interventions for childhood constipation and soiling, but I received a great comment that I would like to address first.

A reader of the blog commented:

As the director of a Montessori school in Colorado, I have a few questions:
1) What are your thoughts about early child care and its effects on attachment? I am aware of Belsky’s study and the NIHCD studies. Do you believe that early child care (before 3) undermines security of attachment? Do you believe this is irrespective of the type or quality of care? Is there other research on this issue that you would recommend?

2) I know there have been a lot of studies (some even specific to child care) which show that infants/young children separated from their parents show abnormally high cortisol levels and lower growth hormone levels. Given these studies, do you have a recommendation as to an optimal way to transition a young child into a child care setting (to minimize their distress)? Is there an optimal way for children to separate from their parents each day (we have tried many things over the years- parents walking their child into the school, children leaving their parents in a car line- a teacher comes out to get the child, etc)? If a child appeared to be highly stressed (how would you quantify this?), what would you recommend? Is there any research as to how specific practices might increase or decrease a child’s experience of separation?

In response to this important comment, I contacted recent graduates of the Infant Parent Mental Health course in Boston and Napa, of which I am on the faculty – http://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health. I value the knowledge and expertise of this group of clinicians and wanted to start a discussion about the issues of childcare, security of attachment, and separation from parents. I will also request comments from another group of valued colleagues – preschool teachers.

My first response came from an IPMH graduate who also has extensive experience directing and administrating early child care programs, Alayne Stieglitz. Here is her thoughtful response:

When I read these questions I thought of Ed Tronick on the first day of the IPMH Program introducing us to the caregiving practices of several cultures around the world: The village in the Andes where infants are bundled in blankets and strapped upside down on their mothers backs for the first year of their lives and the tribal group in Africa where children have an average of seven caregivers before their first birthday. These are not what we would consider ” best practices” but the children there are reaching their developmental milestones, forming healthy, robust attachments, and thriving in their societies. He said, “Different patterns of care taking and parenting may violate norms we hold as vital, yet children are still developing and learning. Those differences work for their culture. The point is to raise a child who can be competent and successful in the culture they live in.”

In this day and age, the culture that an increasing number of families are living in includes childcare. Single parent households and households where both parents work in order to provide what’s needed for their family do not have the option of whether or not to put their children in someone else’s care. There are many choices; in home care by a relative, in home care by a nanny, small family day care, and center based care. I think the question to ask is not, “Which type of care is best?” But, “Which type of care will be best for my child and my family?” And, of course, “Which is the highest quality of care that I can afford?” This last question limits the options for many families. Continue reading →

About

Alexandra Murray Harrison, M.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute in Adult and Child and Adolescent Psychoanalysis, an Assistant Clinical Professor of Psychiatry, Harvard Medical School at the Cambridge Health Alliance, and on the Faculty of the Infant-Parent Mental Health Post Graduate Certificate Program at University of Massachusetts Boston. Dr. Harrison has a private practice in both adult and child psychoanalysis and psychiatry. In the context of visits to orphanages in Central America and India, Dr. Harrison has developed a model for mental health professionals in developed countries to volunteer their consultation services to caregivers of children in care in developing countries in the context of a long term relationship with episodic visits and regular skype and video contact.